Active NPI
Eastside Orthotics and Prosthetics, Inc.
- Prosthetic/Orthotic Supplier
- New York, NY
National Provider Identifier
1982608493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- EASTSIDE ORTHOTICS AND PROSTHETICS, INC.
- Practice address
- 622 W 168TH St
Vc333
New York, NY 10032 - Phone
- (212) 305-3275
- Fax
- (212) 305-5927
- NPI assigned
- Jun 13, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Matthew D Flynn, CP
- Title
- President
- Phone
- (631) 727-8735
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Prosthetic/Orthotic Supplier | 335E00000X | Primary |
Addresses
Primary practice location
622 W 168TH St
Vc333
New York, NY 10032
Mailing address
34 Commerce Dr
Suite 200
Riverhead, NY 11901-3174
Phone (631) 727-8735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01052611 | Medicaid | NY |
National Provider Directory
National Provider DirectoryLocations
622 W 168th St
#333
New York, NY 10032
Phone (212) 305-3275
622 W 168th St
Rm 333
New York, NY 10032
Phone (212) 305-3275
889 Harrison Ave
Ste 2A
Riverhead, NY 11901
Phone (631) 727-8735
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Coral Gables, FL
- NPI 1336438225
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1190160000000",
"number": "1982608493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 COMMERCE DR",
"address_2": "SUITE 200",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119013174",
"telephone_number": "631-727-8735",
"fax_number": "631-727-6834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"address_2": "VC333",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10032",
"telephone_number": "212-305-3275",
"fax_number": "212-305-5927"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EASTSIDE ORTHOTICS AND PROSTHETICS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-06-13",
"last_updated": "2007-09-19",
"status": "A",
"authorized_official_last_name": "FLYNN",
"authorized_official_first_name": "MATTHEW",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "631-727-8735",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CP"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01052611",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
- Eastside Medical Practice, P.C.
- Eastside Medical Radiology PLLC
- Eastside Optometric, P.C.
- Eastside Oral Surgery
- Eastside Orthotics & Prosthetics Inc
- Eastside Physicians of Nyc, PLLC
- Eastside Physicians of Nyc, PLLC
- Eastside Podiatry Associates, PC
- Eastside Private Diagnostic Imaging PLLC
- Eastside Rehab Physical Therapy PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.